Premium solutions for cataract surgery

November 7, 2008

In a series of presentations, speakers at an educational program outlined the benefits of technologies for premium cataract surgery including a microincision platform (Stellaris Vision Enhancement System), an accommodating IOL (the Crystalens HD), and an advanced optics aspheric lens (Akreos), all from Bausch & Lomb. The evening program, held at the Georgia Aquarium, also featured two live cataract surgery cases performed in Beverly Hills, CA, by Uday Devgan, MD.

In a series of presentations, speakers at an educational program outlined the benefits of technologies for premium cataract surgery including a microincision platform (Stellaris Vision Enhancement System), an accommodating IOL (the Crystalens HD), and an advanced optics aspheric lens (Akreos), all from Bausch & Lomb. The evening program, held at the Georgia Aquarium, also featured two live cataract surgery cases performed in Beverly Hills, CA, by Uday Devgan, MD.

Dr. Devgan demonstrated the phacoemulsification system in the first case and implantation of the accommodating IOL in the second. He is the chief of ophthalmology at Olive View-UCLA Medical Center and partner in the Maloney Vision Institute in Los Angeles.

During the symposium presentations, the first speaker, Terence M. Devine, MD, said that safety and efficiency in phacoemulsification depend on balancing multiple technologies, which was the goal during the engineering of the microincision platform. This was done to optimize the surge and control of power and fluidics, to maintain optimum chamber stability, to minimize thermal risk, to create the ideal environment for sub-2-mm surgery, and to maximize premium IOL outcomes, according to Dr. Devine, who is chief, Department of Ophthalmology, Guthrie Clinic, Sayre, PA, and associate professor, State University of New York, Albany.

Program chairman Richard Lindstrom, MD, adjunct professor emeritus, Department of Ophthalmology, University of Minnesota, Minneapolis, discussed the advanced optics aspheric IOL. Although it’s the newest Bausch & Lomb lens on the market in the United States, it has a record of 10 years of clinical experience elsewhere in the world.

The aspheric IOL has a number of advantages, Dr. Lindstrom said, noting that it is made of an advanced acrylic co-polymer with a 26% water content that creates a hydrophilic surface, and it has superior optic quality. It is made of a soft, flexible material that unfolds smoothly, has a UV blocker and good shape memory, and is exceptionally suitable for YAG laser capsulotomy. Dr. Lindstrom also said that the lens is compatible with silicone oil and would be an excellent choice for higher-risk cases.

In clinical trials, the lens was superior to the FDA grid in visual acuity outcomes; 96% of eyes had 20/40 vision or above at 1 year.

Jeffrey Whitman, MD, president and chief surgeon at Key-Whitman Eye Center, Dallas, discussed his experiences with the accommodating IOL, emphasizing binocular results. He presented results from a series of cases (107 eyes) performed within the past several weeks. Binocular results were available for 25 patients.

Based on results, Dr. Whitman said that the accommodating IOL was the best intermediate lens available; 100% of the patients in his study with binocular implants had 20/30 or better, 20/25 or better, or 20/20 or better visual acuity in data from which the outliers had been removed. Results for uncorrected near vision also were strong, and the percentages of patients with good visual acuity remained high when outliers were included in the analysis, Dr. Whitman said.

Alan Aker, MD, founder and medical director of the Aker-Kasten Cataract and Laser Institute, Boca Raton, FL, presented two cases with the accommodating IOL implanted and discussed the differences between multifocal and accommodating lenses. Multifocal lenses are designed to produce multiple points of focus, whereas an accommodating lens is designed to have a single sharp point of focus. Although Dr. Aker said he had successfully implanted many multifocal lenses, he compared multifocal IOLs with "walking in a minefield" and accommodating IOLs with "a walk in the park."

The next speaker, R. Bruce Wallace III, MD, FACS, founder and medical director of Wallace Eye Surgery, Alexandria, LA, said that intermediate vision has become increasingly important as people spend more time on computers and cell phones. He also said that good results with implantation of an IOL depend not just on the lens but on astigmatism correction, proper medications, and surgical technique.

With the accommodating IOL, a technique such as limbal relaxing incisions may be helpful in obtaining the desired results, Dr. Wallace said.

Rosa Braga-Mele, MD, MEd, FRCSC, associate professor, University of Toronto, Canada, closed the program by explaining how all of the technologies can lead to better patient outcomes. The microincision platform is one of many good phacoemulsification devices but stands out for its stability, followability, incision size versatility, and its ability to eliminate larger or more dense cataracts with relatively low power. This equates to quieter eyes on day one and happier patients, Dr. Braga-Mele said.

She also said that she has used the aspheric IOL for 2 years and has found it to be exceptionally stable and well tolerated. She described it as "robust" and "resistant to marking."

Dr. Braga-Mele termed the accommodating IOL her "lens of choice" and her preference for postrefractive cases because it has predictable distance visual outcomes and will not introduce any negative components. The program was supported by Bausch & Lomb in association with Ophthalmology Times.

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